421 IMPACT OF REIMBURSEMENT ON PROSTATE CANCER TREATMENT IN COMMUNITY UROLOGY PRACTICE ANALYSIS OF 1995-2010 LONGITUDINAL DATABASE

INTRODUCTION AND OBJECTIVES: Since the introduction of PSA, the diagnosis and treatment of prostate cancer (CaP) has increased and continues to evolve. We determined the treatment patterns for CaP utilizing a longitudinal database involving a community urology practice over a 16 year period (1995-2010). METHODS: A total of 10,684 patients were diagnosed with CaP by needle biopsy in a single urology practice during the study period. Over 97% of the patients chose to have treatment done by urologists in the practice. The treatment choices of the patients were tracked related to events occurring in physician ownership of treatment services and advances in medical knowledge/technology. Patients were grouped by time of service per year and choice of initial treatment. The treatment categories were: Surgery, Radiation, Androgen Ablation (ADT), and Active Surveillance (AS). The treatment events evaluated were: Physician owned surgery center for brachytherapy (RASI); least costly alternative (LCA)pricing for LHRH agonists; introduction of robotic radical prostatectomy (RoRP); and ownership of EBRT facility. Trends in treatment selection over time were evaluated. RESULTS: The majority of the 10,684 CaP patients in the group, 51.8% (5534), chose radical prostatectomy (RP) as their primary treatment. The remaining patients were divided among other treatments: 25.5% (2719) radiation (12.6% EBRT and 12.9% RASI); 10.3% (1105) active surveillance and 2.0% unknown. Over time the RP group remained consistent at 50%, however the number of open RP decreased with the introduction of RoBP by 2010 (100% to 36%). Although the percentage of patients choosing radiation remained relatively unchanged over time, there was an increase in RASI associated with the availability of the physician owned surgery center and a corresponding decrease in EBRT. After the ownership of EBRT services there was an increase in the EBRT group and a decrease in the RASI group maintaining the overall percentage of patients choosing radiation. The introduction of LCA payment for LHRH did not impact the number of patients selecting ADT as their primary treatment. During the study period, AS was stable at 7-8% per year until 2006 when there was an increase to 15-20% per year. CONCLUSIONS: The management of CaP has evolved in the PSA period as have urologist’s reimbursement. The utilization of RP has remained constant over time while variations are evident in other treatment modalities subject to changes in physician reimbursement and clinical standards of care.